Best Performing Arthroplasty Systems: Evidence-Based Analysis
Total shoulder arthroplasty (TSA) is superior to hemiarthroplasty for glenohumeral osteoarthritis, with better pain relief, improved global health assessment scores, and lower revision rates. 1
Shoulder Arthroplasty Systems
TSA vs. Hemiarthroplasty
- Strong level II evidence supports TSA over hemiarthroplasty for glenohumeral osteoarthritis 1
- Key advantages of TSA:
- Better pain relief and global health assessment scores
- No significant difference in function or quality-of-life measures
- Lower revision rates (14% of hemiarthroplasty patients required revision to TSA due to progressive glenoid arthrosis) 1
Glenoid Component Design
- All-polyethylene glenoid components show significantly lower revision rates (1.7%) compared to metal-backed glenoid components (6.8%) 1
- Radiostereometric analysis shows greater micromotion in keeled glenoid designs, potentially affecting long-term outcomes 1
Surgeon Volume Correlation
- Patients should avoid surgeons who perform fewer than two shoulder arthroplasties per year due to higher complication rates and longer hospital stays 1
Knee Arthroplasty Systems
TKA Design Considerations
- Strong evidence shows no difference in outcomes between posterior-stabilized and posterior cruciate-retaining designs 1
- Strong evidence supports equivalent outcomes with either all-polyethylene or modular tibial components 1
- Strong evidence shows similar functional outcomes and complication rates between cemented and non-cemented tibial component fixation 1
Navigation and Patient-Specific Instrumentation
- Strong evidence does not support using intraoperative navigation or patient-specific instrumentation (PSI) for routine TKA as they show no advantage over conventional instrumentation 1
TKA vs. UKA (Unicompartmental Knee Arthroplasty)
- For isolated medial arthritis, UKA shows decreased risk of deep vein thrombosis, but TKA demonstrates fewer revision surgeries 1
- Third-generation cemented TKA systems show excellent survivorship (95.9% at 8 years) 2
Hip Arthroplasty Systems
Bearing Surfaces
- Ceramic-on-ceramic or ceramic-on-plastic bearings show significantly better survival rates in younger patients (<35 years) 3
- Metal-on-metal bearings require careful monitoring due to potential complications, with some having been recalled 4
Component Matching
- No difference in outcomes between matched components (from same manufacturer) and unmatched components (from different manufacturers) in total hip arthroplasty 5
- After excluding metal-on-metal and ceramic-on-metal bearings, revision rates were similar between matched (4.0%) and unmatched (4.3%) component groups 5
Cervical Arthroplasty
- Bryan disc arthroplasty shows significant improvement in neck pain and function compared to anterior cervical discectomy and fusion (ACDF) 1
- Arthroplasty maintains range of motion at the operated level, with significantly increased motion compared to fusion 1
Clinical Implications and Pitfalls
Key Considerations for Optimal Outcomes
- Surgeon volume significantly impacts outcomes - higher-volume surgeons have lower complication rates 1
- Patient age affects implant survivorship, with younger patients (<25 years) having lower implant survival rates for hip arthroplasty 3
- Primary diagnosis affects long-term outcomes and should guide implant selection 3
Common Pitfalls to Avoid
- Performing TSA in patients with irreparable rotator cuff tears (consensus recommendation against this practice) 1
- Using metal-backed glenoid components in shoulder arthroplasty due to higher revision rates 1
- Selecting metal-on-metal bearings without careful consideration of potential complications 4
- Underestimating the importance of surgeon experience and volume when referring patients 1
By following these evidence-based recommendations for arthroplasty system selection, clinicians can optimize patient outcomes while minimizing complications and revision rates.